Citation Nr: 21068158 Decision Date: 11/09/21 Archive Date: 11/09/21 DOCKET NO. 13-31 406A DATE: November 9, 2021 ORDER Entitlement to service connection for a neck disability, to include as secondary to service-connected left shoulder tendonitis is denied. Entitlement to service connection for a left knee disability, to include as secondary to service-connected bilateral pes planus is denied. FINDINGS OF FACT 1. The weight of the evidence is against a finding that the Veteran's claimed neck disability is the result of an event, injury, or occurrence during active service. 2. The weight of the evidence is against a finding that the Veteran's claimed neck disability is proximately due to, or aggravated by, the Veteran's service-connected left shoulder tendonitis. 3. The weight of the evidence is against a finding that the Veteran's claimed left knee disability is the result of an event, injury, or occurrence during active service. 4. The weight of the evidence is against a finding that the Veteran's left knee disability is proximately due to, or aggravated by, the Veteran's service-connected pes planus. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a neck disability, to include as secondary to service-connected left shoulder tendonitis have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for entitlement to service connection for a left knee disability, to include as secondary to service-connected bilateral pes planus have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from August 1992 to December 1993. These matters originate from a May 2010 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO) that, in pertinent part, denied entitlement to service connection for neck and left knee disabilities, then claimed as "neck pain" and "left knee pain", respectively. These matters were previously before the Board of Veterans' Appeals (Board) in February 2017, July 2019, and May 2021. In May 2021 the Board remanded the Veteran's neck and left knee disability claims to obtain a VA medical opinion that adequately addressed the question of whether the Veteran's neck and left knee disabilities had been aggravated by other, service-connected, disabilities. A remand by the Board confers on the Veteran, as a matter of law, the right to substantial compliance with the remand orders. Stegall v. West, 11 Vet. App. 268, 271 (1998). As discussed further below, opinions addressing this question were obtained in June 2021 and July 2021. Accordingly, the Board finds that there has been substantial compliance with its May 2021 remand directives and adjudication of the Veteran's claims is appropriate. The Board notes that it has reviewed all of the evidence in the record, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Hence, the Board will summarize the relevant evidence as deemed appropriate and the Board's analysis will focus specifically on what the evidence shows, or fails to show, as to the claim. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). The Veteran's November 2009 claim and a November 2013 written statement reflect his contentions that his claimed neck and left knee disabilities are secondary to his service-connected left shoulder tendonitis and bilateral pes planus, respectively. To establish secondary service connection, a Veteran must provide evidence of (1) a current, non-service-connected disability, (2) a current service-connected disability, and (3) evidence that the non-service-connected disability is either (i) proximately due to or the result of a service-connected disability or (ii) aggravated (increased in severity) beyond its natural progression by a service-connected disability. 38 U.S.C. § 1110; Allen v. Brown, 7 Vet. App. 439, 446 (1995); 38 C.F.R. § 3.310. VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established. This baseline is to be established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. 38 C.F.R. § 3.310(b). 1. Entitlement to service connection for a neck disability, to include as secondary to service-connected left shoulder tendonitis March 2017 and June 2021 VA examinations reflect diagnoses of degenerative arthritis of the cervical spine and degenerative disc disease of the cervical spine, respectively. The service treatment records do not reflect any complaints of neck pain, or any diagnosis of or treatment for neck pain or any other neck or cervical spine disability. At a January 2010 VA examination the Veteran reported a gradual onset of neck pain, soreness, and tenderness, that he did not attribute to any in service injury. In January 2021 a VA examiner opined that the Veteran's currently claimed neck disability was less likely than not the result of an in-service event, injury, or occurrence, to include left shoulder tendonitis diagnosed in 1992 while in service. The examiner noted the distinction between the left shoulder and the neck and stated that the in-service left shoulder injury was characterized as a "strain", which would be expected to heal over time. By contrast, the examiner opined that the Veteran's cervical spine disability was the result of "normal wear and tear and aging process." As noted above, the Veteran contends that his currently claimed neck disability is the result of his service-connected left shoulder tendonitis. In June 2021 a VA examiner opined that the Veteran's claimed neck disability was less likely than not the result the Veteran's service-connected left shoulder disability, noting the anatomical distance between the cervical spine and the AC joint and biceps tendon involved in the left shoulder disability. The examiner further noted that the Veteran's left shoulder supraspinatus tendonitis was only reported on imaging studies in September 2020, while the degenerative changes in the Veteran's cervical spine were visible in imaging studies as early as April 2014. The examiner stated that "there is no known pathophysiologic pathway to explain why a shoulder tendinopathy would cause cervical spine degeneration." 06/22/2021, C&P Exam, p. 10. The June 2021 examiner further opined that the Veteran's claimed neck disability was less likely than not aggravated beyond its natural progression by the service-connected left shoulder tendonitis, stating: "the mild findings in [a left shoulder imaging study] are anatomically located in an area that is not close to the cervical spine and physiologically, there is no explanation for how a tendinopathy could cause cervical disc degeneration . . . the cervical degeneration precedes the finding of [left] shoulder supraspinatus tendonitis by six year[s]. . . The pathology of cervical degeneration is unaffected (not aggravated) by the [left] shoulder tendonitis." Given the foregoing, the Board finds that the weight of the evidence is against a finding that the Veteran's claimed neck disability had its onset in service and/or is etiologically related to his active service, to include being proximately due to or aggravated by a service-connected disability. Accordingly, service connection for a neck disability is not warranted on any basis. In reaching the above conclusions, the Board also considered the doctrine of reasonable doubt. 38 U.S.C. § 5107 (b). However, as the preponderance of the evidence is against the claim, the doctrine is not for application. See e.g. Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Therefore, service connection for a neck disability is denied. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. Entitlement to service connection for a left knee disability, to include as secondary to service-connected bilateral pes planus A July 2021 VA examiner recorded a diagnosis of bilateral, to include left knee, degenerative arthritis of the knees. The Veteran reported that the pain began "many years ago." The Veteran's STRs do not reflect any complaints or diagnosis of, or treatment for, a knee injury. A May 2007 VA outpatient treatment note reflects that the Veteran denied any pain or weakness in his left lower extremity. 09/17/2013, CAPRI, p. 285. In October 2008 the Veteran reported to VA treating providers reporting bilateral knee pain, but denied a history of painful popping or crackling, or of his knees giving out on him. In February 2009 the Veteran reported that his left knee had been bothering him for "several months." Id. at 229. In June 2009 the Veteran reported left knee pain dating back two months. Id. at 201. At a January 2010 VA examination the Veteran reported gradual onset of left knee pain, which he did not attribute to any specific event, in-service or otherwise. A January 2021 VA examiner opined that the Veteran's left knee arthritis was less likely than not the result of any in-service injury, event, or occurrence. As noted above, the Veteran contends that his currently claimed neck disability is the result of his service-connected bilateral pes planus. In July 2021 a VA examiner opined that the Veteran's left knee arthritis is "early and mild" and "is consistent with natural, age progression osteoarthritis." 07/29/2021, C&P Exam, p. 27. The examiner noted that the Veteran's bilateral knee arthritis is more severe on the right side, contrary to expected findings were the Veteran's left knee arthritis related to his pes planus. The examiner concluded that the Veteran's left knee arthritis was less likely than not proximately due to or aggravated by his bilateral pes planus. Given the foregoing, the Board finds that the weight of the evidence is against a finding that the Veteran's claimed left knee disability had its onset in service and/or is etiologically related to his active service, to include being proximately due to or aggravated by a service-connected disability. Accordingly, service connection for a left knee disability is not warranted on any basis. In reaching the above conclusions, the Board also considered the doctrine of reasonable doubt. 38 U.S.C. § 5107 (b). However, as the preponderance of the evidence is against the claim, the doctrine is not for application. See e.g. Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Therefore, service connection for a left knee disability is denied. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Sametshaw, Eric C. The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.